In his latest online article, Mr Pedro Oliveira Castanho gives us his insights into meningioma. He talks about what meningioma is, the causes, how it’s detected, if it should be removed, treatment options, the benefits and side effects and the outlook.

What is meningioma, and what are the causes?

Meningioma is a tumour originating from the membranes enveloping the brain and spinal cord. Generally, they are non-cancerous growths, although occasional cases may exhibit more aggressive behaviour. Rarely, malignant forms can occur, particularly in individuals with specific genetic predispositions.

Determining a singular cause for meningiomas proves challenging, as they typically arise from a complex interplay of various factors rather than a singular origin. While hormonal influence, particularly in women, has been suggested, this connection remains incompletely understood. Recognised risk factors include exposure to radiation and the presence of certain genetic conditions like neurofibromatosis type 2, though these represent a minority of cases.

How are meningioma typically detected?

Brain scans may incidentally reveal meningiomas, even before they manifest any symptoms, often occurring during scans conducted for unrelated reasons such as falls or accidents. Patients with meningiomas may present with a range of symptoms, either individually or in combination. These symptoms encompass headaches, epileptic seizures, alterations in behaviour or memory, weakness and sensations in the arms or legs, facial drooping, and double or blurred vision, among others. The absence of specific symptoms for meningiomas highlights the variability, influenced by factors like location, size, and the extent of swelling within the brain.

When should meningiomas be removed?

If there are clear signs of significant symptoms, growth on consecutive scans, or indications of more aggressive behaviour, it may be necessary to consider surgical removal.

What treatment options are available for meningiomas?

Surgery to either remove or shrink the tumour is often advised for the mentioned tumours. Another option is the Gamma Knife, which might be the preferred treatment for certain patients, aiming to prevent tumour growth. In some cases, merely monitoring with regular imaging may be sufficient for managing meningiomas. Currently, there is no medication specifically designed to treat these tumours effectively. However, various medications can assist in symptom control, such as alleviating headaches, managing seizures, or reducing brain swelling. In certain situations, a combination of these treatments and other approaches may be necessary.

Can you explain the benefits and potential side effects of each treatment?

The term “Gamma Knife” might sound misleading because there’s no cutting involved. It’s a minimally invasive procedure where targeted gamma rays are used on the tumour, minimising impact on the surrounding brain. Despite the unusual idea of using radiation for tumours caused by it, the high dose is precisely aimed at the unhealthy tissue. Usually done in a day and as a single treatment, the procedure might take a few minutes to a few hours. Beforehand, you’ll be admitted for necessary investigations.

While generally well-tolerated, common symptoms on the day may include headaches, dizziness, and light-headedness, manageable with later medication. Temporary hair loss and transient brain swelling, also controllable with medication, are potential experiences for patients. Long-term side effects are rare, with exceedingly rare occurrences of radiation necrosis and radiation-induced tumours.

On the other hand, surgery has the potential to cure but is the most invasive option, requiring general anaesthesia. Operations usually go as planned with common post-operative effects like wound pain and swelling. However, there is a small risk of serious complications or death, and the severity of risks varies depending on the tumour’s complexity.

What is the outlook for meningiomas?

Meningiomas are complex tumours that usually need long-term monitoring, no matter how they’re treated. The good news is, with the right care, they’re often curable or manageable. In these cases, people should be able to lead a regular life and have a normal life expectancy.

The mystery of why some diseases such as multiple sclerosis (MS) are more prevalent in some parts of Europe is closer to being understood after a recent study by an international team of researchers. BBC News reports that the new information could shed new light on what causes MS and impact on the way that it is treated.

MS is a neurological condition that affects the central nervous system. It occurs when the immune system mistakenly attacks the protective insulating layer of nerve fibres, disrupting the messages between the brain and the body.

This causes a range of symptoms such as stiffness, spasms, tremors, numbness, fatigue, loss of balance, vision problems, pain, bladder and bowel problems, and problems with memory and concentration. The symptoms vary in type and severity from person to person, and can recur and relapse, or get progressively worse over time.

It’s estimated that about 130,000 people in the UK are living with MS, and globally the number is thought to be around 2.5 million people. The distribution of cases around the world is uneven, with very low rates in countries that lie south of the equator, and particularly high rates for countries in the northern hemisphere such as Canada and Scotland.

The new research carried out by scientists from the universities of Cambridge, Oxford, and Copenhagen may shed light on the reason for this uneven distribution. They studied the teeth and bones of our about 5,000 ancient ancestors who entered north western Europe around 34,000 years ago.

These ancient people were cattle herders known as Yamnaya and they came from western Russia and bordering eastern European nations. Scientists have discovered that these people had gene variants that protected them from animal diseases.

However, in the modern era these genes can put us at a disadvantage, making people more vulnerable to developing certain neurological diseases, including MS and Alzheimer’s disease. So far, very little is understood about the exact causes of these diseases and why some people are more prone to them than others.

The experts sequenced the ancient human DNA and mapped the historical spread of the genes in migration patterns over time. The ancient DNA was compared to modern-day samples to shed light on the differences.

Professor Fugger, co-author of the paper published in the journal Nature said: “MS is not caused by mutations – it’s driven by normal genes to protect us against pathogens.”

MS is currently treated by suppressing the body’s immune system, but this can leave the patient vulnerable to infections. Prof Fugger explained: “When treating it, we are up against evolutionary forces. We need to find the sweet spot where there is a balance with the immune system, rather than wiping it out.”

Prof Fugger added: “This means we can now understand and seek to treat MS for what it actually is: the result of a genetic adaptation to certain environmental conditions that occurred back in our prehistory.”

The researchers also found further clues as to why northern Europeans tend to be taller than their southern counterparts.

If you would like to find out more about Gamma Knife surgery and multiple sclerosis treatment, please contact Mr Jonathan Hyam of Amethyst Radiotherapy.

The comedian Miles Jupp has discussed his recovery from a brain tumour, as he prepares to take to the stage again in January. Jupp is well loved for his comedy performances and also his acting roles in the CBeebies show Balamory, the Harry Potter films, The Thick of It, and Rev.

Jupp is appearing in the upcoming Ridley Scott film about the life of Napoleon, The Emperor of Austria, and is also about to embark on an extensive stand up tour of the UK between January and May.  He uses some of his recent experiences in the medical sector as inspiration for his comedy material.

In 2021, Jupp was diagnosed with a benign brain tumour after having a seizure. He subsequently underwent surgery to remove a tumour the size of a cherry tomato.

Although benign tumours are non-cancerous and unlikely to spread, they can press on important nerves in the brain and cause serious side effects such as seizures, vision disturbances, fatigue, loss of coordination, memory problems, and muscle weakness.

Jupp said of using his experience as stand up material: “I found being in hospital very uplifting, partly because you’re just surrounded by people who are very caring. It’s not me moaning about unsatisfactory customer experience. Hopefully it’s pure storytelling with a beginning, a middle and an end.”

Jupp has since made a good recovery from the neurosurgery, which is the main treatment for non-cancerous brain tumours. If it is not possible to remove the entire tumour, further treatment involving chemotherapy or radiotherapy may be undertaken.

Radiosurgery involves targeting the tumour with highly controlled doses of high-energy radiation to kill the tumour cells. It causes minimum damage to the surrounding cells, and avoids the need for invasive traditional surgery that involves cutting into the skull.

There are different types of radiotherapy machines, which generally either deliver standard external beam radiotherapy or stereotactic radiotherapy (SRT). The latter is used to deliver highly targeted beams that may be of a higher dose, which means that the treatment can be carried out in fewer sessions.

Some radiotherapy machines, such as Gamma Knife, are designed specifically to deliver SRT treatment.

Jupp discussed his experience further in an interview with Virgin Radio: “It’s terrifying. I sort of wrote it down after a while because, when I was first getting better, I was struggling to put things in order. At one point, I’d have to think for ages to remember the word ‘tumour’, which was, at that point, quite central to my life. So I thought I better start writing it down.”

Miles continued: “Every aspect of normal life when you go back, it scares you to do something for the first time. There was a period where I was doing things for the first time since the operation and thinking, ‘Will I still be able to do this particular thing? Will I still be able to ride a bike?'”

Jupp has fortunately recovered well and has used the experience as the basis of his new stand up routine.

For more information about brain tumour treatment, please contact Mr Andrew McAvoy of Amethyst Radiotherapy.

Acoustic neuroma, also known as a vestibular schwannoma, is a benign (non-cancerous) tumour that develops on the cranial nerve. This is the nerve that runs from the inner ear to the brain and controls the hearing and balance. Therefore although it is non-cancerous it can have serious side-effects and symptoms, and may require treatment.

The tumour will not spread to other parts of the body, but it can disrupt the ability of the eighth cranial nerve to transmit signals to the brain, resulting in problems with balance and hearing. It may also affect the facial nerves, making it difficult for patients to move facial muscles and carry out functions such as swallowing.

They are a rare type of tumour, and in many cases the typical symptoms have another cause of explanation. However, if symptoms such as hearing loss (often in one ear more than the other), tinnitus (a persistent ringing sound in the ears) or dizziness and difficulty with balance are present, these should be investigated further by a doctor.

The doctor may arrange an MRI scan to confirm or rule out the presence of an acoustic neuroma. If the diagnosis is positive, it can be an overwhelming experience. If the symptoms are not causing serious problems, it may be decided to actively monitor the tumour with regular scans but carry out no further treatment.

An acoustic neuroma that is causing troublesome symptoms may be removed with surgery or treated with radiation therapy to curb its growth. The type of treatment may depend on the size of the tumour, the severity of the symptoms, and the general age and state of health of the patient.

When the tumour has been successfully treated, this is often just the first step in the journey, as most patients will need to go through a process of rehabilitation and recovery. This process is multi-focused and will depend on the symptoms and side effects that are present. It will be tailored to individual patients, but may involve the following:

Neuro physiotherapy to regain balance and mobility. This may involve learning how to sit up straight and walk using supports, and eventually regaining the ability to walk independently.

Speech and language therapy to improve swallow function and vocal strength, and facial physiotherapy to improve facial function. It may also include occupational therapy to help the patient regain full control of their upper limbs and improve coordination, and specialist vestibular therapy to help regain control over balance.

The patient may also require neuropsychology if they have experienced issues with cognitive function and memory processing. These can be huge hurdles that require a lot of hard work and determination to overcome.

For more information about acoustic neuroma treatment, please contact Mr Patrick Grover of Amethyst Radiotherapy.